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Results for “Practice Guidelines as Topic”

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At least 343 records · Page 19Linked to original sources

PubMed2002

Rational use of antibiotics to treat respiratory tract infections.

OBJECTIVES: To foster the appropriate use of antimicrobial agents for respiratory tract infections and to review factors that should help achieve this objective. STUDY DESIGN: Review of evidence-based guidelines and recommendations for proper antibiotic drug use for respiratory tract infections. RESULTS AND CONCLUSIONS: Antibiotic drug overuse and inappropriate antibiotic drug selection are associated with increased drug resistance among respiratory pathogens (most notably, Streptococcus pneumoniae), possible progression to chronic disease, and increased treatment costs. Awareness of clinical manifestations that help differentiate viral from bacterial infection and the use of guidelines can promote the appropriate management of respiratory tract infections. Community-acquired pneumonia, acute bacterial rhinosinusitis, and selected cases of acute exacerbations of chronic bronchitis (50%) warrant antimicrobial therapy, whereas otitis media with effusion, acute bronchitis, and most rhinosinusitis are viral and do not require antibiotic therapy.

Anti-Bacterial Agents↗

PubMedDate not supplied

Follow-up of infants prenatally exposed to cocaine.

Maternal cocaine use during pregnancy continues to be of great concern for health care professionals. Research in this area has increased as investigators examine the effects of prenatal cocaine exposure in the infant/young child. This paper will critically review the literature, identify the primary care needs of infants and young children with a known history of prenatal cocaine exposure, and present guidelines for the primary care practitioner to monitor the infant's physiologic and developmental sequelae during the first 3 years of life. Findings in the literature demonstrate inconsistencies in regard to the physiologic and developmental outcomes of infants/young children prenatally exposed to cocaine. Further research is warranted, as it is evident from studies that not all investigators are controlling for confounding variables such as poly-drug use, which is necessary in isolating cocaine's effects. Subtle effects, however, have been reported from well-controlled studies and, thus, particular attention needs to be paid to early identification and interventions by primary care practitioners to prevent negative health outcomes. The guidelines proposed assist the practitioner with a thorough and focused approach to assessing the physiologic and developmental effects that are currently known to occur in the infant/young child prenatally exposed to cocaine.

Aftercare↗

PubMed1996

Developing a local protocol for the management of lipid disorders in general practice.

Guidelines and protocols are increasingly becoming part of routine clinical practice. A standardised methodology has been proposed for the development of national guidelines based on principles which are known to effect validity. However, less is known about the most appropriate methodology for the development of local protocols. A case study is presented of the development of a local protocol for the management of lipid disorders in primary care in Grampian. It highlights the practicalities of such a process and identifies lessons for others who may wish to develop local protocols.

Clinical Protocols↗

PubMed2007

Examination of the analytic quality of behavioral health randomized clinical trials.

Adoption of evidence-based practice (EBP) policy has implications for clinicians and researchers alike. In fields that have already adopted EBP, evidence-based practice guidelines derive from systematic reviews of research evidence. Ultimately, such guidelines serve as tools used by practitioners. Systematic reviews of treatment efficacy and effectiveness reserve their strongest endorsements for treatments that are supported by high-quality randomized clinical trials (RCTs). It is unknown how well RCTs reported in behavioral science journals fare compared to quality standards set forth in fields that pioneered the evidence-based movement. We compared analytic quality features of all behavioral health RCTs (n = 73) published in three leading behavioral journals and two leading medical journals between January 2000 and July 2003. A behavioral health trial was operationalized as one employing a behavioral treatment modality to prevent or treat an acute or chronic physical disease or condition. Findings revealed areas of weakness in analytic aspects of the behavioral health RCTs reported in both sets of journals. Weaknesses were more pronounced in behavioral journals. The authors offer recommendations for improving the analytic quality of behavioral health RCTs to ensure that evidence about behavioral treatments is highly weighted in systematic reviews.

Behavioral Medicine↗

PubMed2005

Spinal cord injury and pressure ulcers.

The SCI person is at high risk for pressure ulcers; thus, pressure ulcer prevention is a critical component of care. Guidelines exist to promote evidenced-based practice for the prevention and treatment of pressure ulcers in the SCI. There is a discrepancy between what persons with SCI know about pressure ulcer prevention and what they are doing to reduce their risk of developing this serious complication. Objective data demonstrate that adherence to a skin care regimen contributes to the prevention of pressure ulcers. Knowledge about pressure ulcer prevention and treatment must be appropriately focused for the patient, family, and the health care team and must be reinforced over time.

Education, Nursing↗

PubMed1995

[The present status and problems of phase III clinical trials of the new anti tumor drug-pharmaceutical company's view].

Daiichi Pharmaceutical Co., Ltd. obtained the Japanese manufacturing approval of irinotecan hydrochloride (CPT.-11) in January 1994, which was developed through the collaboration with Yakult Honsha Co., Ltd. Prior to the approval, the manufacturer submitted to the Japanese MHW the draft protocols for phase III studies of the drug required to be conducted after its approval under the Guidelines for the Clinical Evaluation of Anti-tumor Drugs, which was promulgated in February 1991. As these studies were to be conducted as part of post-marketing surveillance, the manufacturer encountered various types of questions and complicated problems in designing the studies. Thus, the present report describes the pharmaceutical company's view on the present status and problems of phase III studies of novel anti-tumor drugs in Japan.

Antineoplastic Agents↗

PubMed2005

[Consensus on asthma diagnosis and treatment in children and adults].

Asthma is a chronic airway disease that is a growing problem of public health. The current consensus is based on the Global Initiative for Asthma (GINA) and other guidelines for asthma, and adapted for Lithuania. This Consensus provides physicians with recommendations for asthma management in children and adults.

Adolescent↗

PubMed2000

Organizational systems used by California capitated medical groups and independent practice associations to increase cancer screening.

BACKGROUND: Patients in health maintenance organizations (HMOs) appear to have higher utilization of cancer screening tests than patients with fee-for-service insurance. METHODS: The authors surveyed the medical directors of 174 physician organizations in a California network model HMO to obtain information regarding their organizational structure, implementation of guidelines, and use of systems to increase cancer screening. RESULTS: The majority of independent practice associations (IPAs) and medical groups (IMGs) in this California HMO had guidelines and office systems aimed at improving cancer screening. These activities were reported more frequently for mammography and Papanicolaou (Pap) smears than for colorectal carcinoma screening. IMGs reported using flow sheets more often than IPAs. Chart audits were performed more frequently for mammography (48% for IMGs and 40% for IPAs) and Pap smears (45% and 40%, respectively) than for colorectal carcinoma screening (38% and 30%, respectively). Approximately 50% of IPAs and IMGs reported mailing reminders to patients for mammography and Pap smears, but only a few did so for colorectal carcinoma screening. Annual fecal occult blood testing was believed by most medical directors to be a reasonable strategy for managed care patients (86% of IPAs and 96% of IMGs); however, fewer believed that screening sigmoidoscopy for patients ages 50-70 years was a reasonable expectation (71% and 78%, respectively). CONCLUSIONS: The majority of IPAs and IMGs in this California HMO reported using both guidelines and office systems to improve cancer screening rates. Further research is needed to understand the effect of these systems, as well their complex interactions with competing incentives, on cancer screening in managed care patients.

Adult↗

PubMed2005

The assessment and management of cancer treatment-related diarrhea.

Cancer treatment-induced diarrhea affects a high percentage of patients with cancer that receive chemotherapy or radiation treatment. Widely used criteria for measuring treatment-induced diarrhea, such as the National Cancer Institute Common Toxicity Criteria, do not account for important characteristics of treatment-induced diarrhea. These characteristics include the assessment of the duration of the diarrhea, coexisting symptoms, abdominal cramping, or the presence of nocturnal diarrhea. Until recently, there were no universally accepted guidelines for the management of diarrhea. An expert panel developed guidelines with recommendations regarding assessment of the patient and treatment. These guidelines stress the importance of a thorough assessment of the patient, and treatment based upon severity of symptoms. By employing these guidelines, the aggressive management of diarrhea may impact the overall morbidity of this symptom. Education regarding the importance of diarrhea is essential. Patients who are informed will better understand their role in managing this side effect and when to contact their health care provider with emergent symptoms. Early recognition and management of diarrhea will be essential to improve control of diarrhea, and in turn will positively impact patients' quality of life.

Antidiarrheals↗

PubMed1997

[Patient education responsibility, specialty and administration information from the internal medicine viewpoint].

Drug therapy requires both the thorough education of the patient by the physician and the patient's consent. The contents of the patient education should be based on the urgency of drug therapy, the patient's educational background, and his level of knowledge. Besides the instructions and explanations given to medicine users by physicians or pharmacists, the written patient information leaflet represents the main source of information. The objectives of the written information concerning a pharmaceutical product are to provide patients with clear information about the drug and, thus, to improve the drug compliance. Guidelines of the European Community (EC) for the writing of drug information leaflets (guideline 92/27) will hopefully lead to a more consumer-oriented drug information. The data sheet should give medical specialists the detailed information needed to safely use the drug. The note for guidance "Summary of Product Characteristics", recently proposed by the CPMP (Committee for Proprietary Medicinal Products) of the EC, provides detailed instructions on how to present drug information.

Adverse Drug Reaction Reporting Systems↗

PubMed1999

Patellofemoral pain syndrome: a review and guidelines for treatment.

Managing patellofemoral pain syndrome is a challenge, in part because of lack of consensus regarding its cause and treatment. Contributing factors include overuse and overload of the patellofemoral joint, biomechanical problems and muscular dysfunction. The initial treatment plan should include quadriceps strengthening and temporary activity modification. Additional exercises may be incorporated as dictated by the findings of the physical examination. Footwear should be closely evaluated for quality and fit, and the use of arch supports should be considered.

Anti-Inflammatory Agents↗

PubMed1999

Sexually transmitted infections in female rape victims.

Sexual assault is a common occurrence that carries significant physical and mental health morbidity. Some of the most common concerns expressed by sexual assault victims can be allayed by addressing the risks of rape-related sexually transmitted infections. Although exact risks cannot be accurately quantified, it is important that health-care professionals provide counseling as well as prophylaxis and/or treatment as indicated. Screening and treatments should follow established guidelines, and follow-up care is indicated to confirm successful prevention or treatment. Continued support, surveillance, and medical attention should be offered as needed. This article will address important clinical issues regarding the prevalence and consequences of sexual assault, and will summarize current recommendations for the prophylaxis and treatment of sexually transmitted infections in adolescent and adult rape victims. Some of the logistical issues surrounding HIV testing, counseling, and prevention for rape victims will also be addressed.

Adolescent↗

PubMed1996

The effect on patients of non-referral for skull radiography following mild head injury.

This paper assesses the attitude of 705 patients who attended the Accident department of a large metropolitan district general hospital, with a mild head injury and who were not referred for skull radiography. A questionnaire was sent to patients 5-7 months after they had attended. Fifty-one per cent had expected an X-ray, and when this did not occur, the majority of this group (63 per cent) left the Accident department disappointed. Furthermore, the duration of symptoms in this group was prolonged. The introduction of guidelines may reduce clinically unnecessary X-ray examinations, but some of the consequences may not be fully appreciated. In this study, a significant number of patients were dissatisfied with the lack of X-ray referral. The main cause for the associated prolongation of symptoms is not clear, but a contributory factory may be that lack of referral for radiography led to anxiety concerning the thoroughness of their management.

Attitude to Health↗

PubMed2006

Statin treatment and adherence to national cholesterol guidelines after ischemic stroke.

BACKGROUND: National cholesterol guidelines have defined high vascular risk individuals as those who could potentially benefit most from statin therapy. The authors aimed to determine the rate of statin use, its predictors, and the achievement of national guideline target lipid goals among ischemic stroke survivors. METHODS: The authors abstracted data from the Vitamin Intervention for Stroke Prevention (VISP) study database from the United States and Canada to incorporate into algorithms for initiating statin therapy according to the National Cholesterol Education Program (NCEP) guidelines for high-risk individuals. The authors applied these algorithms to all study subjects. Univariate as well as multivariate associations for target lipid levels and statin implementation were then evaluated utilizing pertinent demographic, clinical, and laboratory data. RESULTS: Of 2,894 subjects in the analysis dataset, 38% were women; 71% were recruited in the United States and 29% in Canada. Of 769 high-risk subjects, 262 (34%) had a low-density lipoprotein (LDL) level > or =130 mg/dL and 124 of these (47%) were not on statin. Among those high-risk persons on statin treatment, only 42% had an LDL < or =100 mg/dL. Subjects in the overall cohort were more likely to be on a statin if they were treated in the United States or had a history of hypertension or coronary artery disease. CONCLUSIONS: Approximately one out of three guideline-eligible high vascular risk ischemic stroke patients in this study had low-density lipoprotein cholesterol concentrations above qualifying levels for pharmacologic therapy, but half of these patients were not taking a statin, and of those receiving statin treatment, less than half were within recommended lipid goals.

Adult↗

PubMed1998

Understanding the guidelines for treating HIV disease.

In 1996 a panel of experts convened by the International AIDS Society-USA issued new guidelines for treating human immunodeficiency virus (HIV) infection, which have recently been updated. Quantitative plasma HIV-1 RNA concentration (viral load) and CD4+ lymphocyte levels are used to monitor disease progression, determine the need to initiate antiretroviral treatment, monitor effectiveness of treatment and evaluate the need to change medications. Multi-drug therapy with nucleoside analogs, nonnucleoside reverse transcriptase inhibitors and protease inhibitors can result in measurable improvement in clinical outcome in HIV-1 infected patients.

Anti-HIV Agents↗

PubMed2004

Ethical guidelines for assisting patients with end-of-life decision making.

The medical-surgical nurse must be prepared to care for patients at the end of life as they face a multitude of complex issues surrounding physical, psychological, and spiritual needs. End-of-life care must not only control symptoms, but also address the social, psychological, and spiritual needs of the patient. By using a decision framework, the nurse will be better prepared to assist patients in exploring options for end-of-life care.

Advance Directives↗

PubMed1999

Take care: guidelines for patients with chronic hepatitis C.

Alcohol consumption has significant impact on the condition of the liver, by itself, and even more in conjunction with other liver diseases such as chronic hepatitis C. Drinking habits might be delicate issues to address and could harm otherwise satisfying communication. Therefore, we intended to outline guidelines for advising hepatitis C patients concerning alcohol consumption. Analysis of a relatively limited knowledge base revealed the complexity of the disease rather than statistically significant findings regarding consumption. Thus, we instead chose to suggest a set of patient educational guidelines, which could be implemented on the Internet, hypothesizing that a better informed patient will be more able to comply with restrictions concerning alcohol consumption. A brief ad hoc evaluation pointed out Internet as a favourable media to present the information. We also suggest a tentative algorithm for further development of clinical decision support systems addressing monitoring of chronic hepatitis C patients.

Adolescent↗

PubMed2002

The impact of the National Cholesterol Education Program Adult Treatment Panel III guidelines on drug development.

In the newest guidelines of the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III, more intensive low-density lipoprotein cholesterol-lowering therapy, together with more attention to other lipid and lipoprotein parameters, are recommended for a larger group of dyslipidemic patients than was covered under ATP I and ATP II. A discussion to evaluate how future drug development might be affected by these new guidelines took place at the 14th International Symposium on Drugs Affecting Lipid Metabolism (DALM) conference, held in New York in September 2001. These discussions involved how to develop new lipid-lowering drugs in an era in which so much compelling evidence demonstrates the benefits of statins. Also covered were issues related to the development of drugs with triglyceride indications and whether the proportion of patients achieving NCEP guidelines should be included in the label of lipid-lowering drugs. Additional topics discussed included: (1) the possibility of incorporating a non-high-density lipoprotein cholesterol (HDL-C) indication for lipid-lowering drugs, (2) the possibility of obtaining indications for lipid-lowering drugs specifically in patients with diabetes, (3) the place of combination lipid-lowering drug therapy in drug development, and (4) whether drugs could be approved to increase levels of HDL-C in patients with isolated low HDL-C.

Adult↗